From the Guidelines
When converting from Concerta 54 mg to Ritalin LA, the equivalent dose would be approximately 60 mg of Ritalin LA. This conversion is based on the different release mechanisms of these two methylphenidate formulations, as noted in the practice parameter for the use of stimulant medications 1. Concerta uses an osmotic-release oral system (OROS) that provides consistent medication release over about 12 hours, while Ritalin LA uses a biphasic delivery system with two releases about 4 hours apart. The conversion isn't exactly 1:1 because of these different delivery mechanisms. Some key points to consider when making this conversion include:
- Starting with the equivalent dose and then adjusting as needed based on clinical response and side effects
- Monitoring the transition by a healthcare provider who can assess effectiveness and tolerability
- Recognizing that some patients may experience differences in how they respond to each formulation despite the dose equivalence, as individual metabolism and response to the different release mechanisms can vary, as seen in studies on the use of stimulant medications in the treatment of children, adolescents, and adults 1. It's also important to note that the new medication called OROS-MPH (Concerta) has been shown to be a useful alternative to older stimulant medications, and children naïve to stimulant treatment may be started directly on the 18-mg Concerta, which is equivalent to MPH 5 mg 3 times daily 1.
From the Research
Conversion of Concerta to Ritalin LA
- The conversion of Concerta to Ritalin LA is not directly addressed in the provided studies, but we can look at the dosing and efficacy of both medications to make an informed comparison.
- A study from 2003 2 compared the efficacy of Ritalin LA and Concerta in children with attention deficit hyperactivity disorder (ADHD), but it did not provide a direct conversion ratio.
- Another study from 2004 3 compared the efficacy of Metadate CD and Concerta, and found that equivalent levels of morning symptom control could be obtained with lower daily doses of Metadate CD than Concerta.
- However, the study also found that the situation was reversed in the evening, with Concerta providing greater control at 12 hours post-dose.
Dosing Comparison
- The 2004 study 3 used the following dosing comparisons:
- Metadate CD 20 mg vs Concerta 18 mg (low dose)
- Metadate CD 40 mg vs Concerta 36 mg (medium dose)
- Metadate CD 60 mg vs Concerta 54 mg (high dose)
- Based on this study, we can infer that Concerta 54 mg may be comparable to Ritalin LA 60-70 mg, but this is not a direct conversion and should be used with caution.
Efficacy and Safety
- The studies suggest that both Concerta and Ritalin LA are effective in treating ADHD symptoms, but the efficacy and safety profiles may differ between the two medications.
- A 2015 review 4 found that methylphenidate (the active ingredient in both Concerta and Ritalin LA) may improve teacher-rated ADHD symptoms and general behavior, but may also increase the risk of non-serious adverse events such as sleep problems and decreased appetite.
- An updated review from 2023 5 found similar results, with methylphenidate improving teacher-rated ADHD symptoms and general behavior, but with very low-certainty evidence due to the high risk of bias in the included trials.